Dupuytrens disease
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Transcript of Dupuytrens disease
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Dupuytrens DiseaseDupuytrens Disease
Dr Steve CarterDr Steve Carter
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IntroductionIntroduction Dupuytrens description 1831Dupuytrens description 1831 Plater 1614 Scandinavian literature 1700Plater 1614 Scandinavian literature 1700 Cline proposed fasciectomy in 1787Cline proposed fasciectomy in 1787 Cooper performed first fasciectomy 1822Cooper performed first fasciectomy 1822
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EpidemiologyEpidemiology Common in Northern Europe 16% rises to 60% in Common in Northern Europe 16% rises to 60% in
relativesrelatives Associations, diabetes, TB, Aids,Seizure disorders minor Associations, diabetes, TB, Aids,Seizure disorders minor
traumatrauma Essentially Fibroblasts converted to myofibroblasts Essentially Fibroblasts converted to myofibroblasts
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Anatomy / PathophysiologyAnatomy / Pathophysiology Palmar fascia triangular shape base at mcpsPalmar fascia triangular shape base at mcps 4 longitudinal bands attached to skin intrinsic muscles4 longitudinal bands attached to skin intrinsic muscles
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Anatomy / PathophysiologyAnatomy / Pathophysiology Begins as a palmar noduleBegins as a palmar nodule Extends distally as a cord Type 3 collagen Extends distally as a cord Type 3 collagen
myofibroblastsmyofibroblasts
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ClinicalClinical Nodule / contractureNodule / contracture Activities of daily livingActivities of daily living Knuckle padsKnuckle pads Ledderhose Peyronies diseaseLedderhose Peyronies disease Other assoc CTS Trigger fingerOther assoc CTS Trigger finger Differentiation from BoutonniereDifferentiation from Boutonniere
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Non operative treatmentNon operative treatment Steroids Anti-inflamatoriesSteroids Anti-inflamatories Clostridium collegenase Clostridium collegenase Mainstay of treatment remains surgicalMainstay of treatment remains surgical
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Surgical IndicationsSurgical Indications Activities of daily living, Table top testActivities of daily living, Table top test MCP > 30 degree contractue MCP > 30 degree contractue PIP > 20 Degree contracturePIP > 20 Degree contracture
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Surgical IndicationsSurgical Indications
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Surgical treatmentSurgical treatment Fasciotomy Fasciotomy
Regional FasciectomyRegional Fasciectomy
Total FasciectomyTotal Fasciectomy
DermatofasciectomyDermatofasciectomy
Segmental AponeurectomySegmental Aponeurectomy
McCash open palm techniqueMcCash open palm technique
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Surgical treatmentSurgical treatment Skin IncisionsSkin Incisions
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Surgical treatmentSurgical treatment DissectionDissection
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Surgical treatmentSurgical treatment Joint releaseJoint release
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Surgical treatmentSurgical treatment HeamostasisHeamostasis
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Surgical treatmentSurgical treatment Skin ClosureSkin Closure
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Surgical treatmentSurgical treatment PostoperativePostoperative
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Surgical treatmentSurgical treatment
ComplicationsComplications HeamatomaHeamatoma Skin necrosesSkin necroses InfectionInfection Digital nerve and arteryDigital nerve and artery RSDRSD StiffnessStiffness Loss of strengthLoss of strength RecurrenceRecurrence
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ConclusionConclusion